The Physician Organizational Leadership Crisis

The physician organizational leadership crisis – and growing physician disenchantment with the AMA – reminds me of Robert Browning’s poem The Pied Piper of Hamelin City,

And out of the houses, the rats came tumbling,
Great rats, small rats, lean rats, brawny rats,
Brown rats, black rats, gray rats, tawny rats,
Grave old plodders, gay young friskers,
Fathers, mothers, uncles, cousins,
Cocking tails and pricking whiskers,
Families by tens and dozens,
Brothers, uncles, husbands, wives -
Followed the Piper for their lives.


A Diverse Bunch

Not that doctors are rats, but we’re a diverse bunch, and many of us looking for a Pied Piper besides the AMA. If I were to rewrite the Browning verse, it would read,

And out of the House of Medicine, the docs came tumbling,
Group docs, solo docs, happy docs, sad docs,
Specialty docs, primary docs,
Town docs, gown docs,
Grave old conservatives,
Pricking young progressives,
Independent docs, employed docs,
Hospitalist docs, locum docs.
Cocky thriving specialists,
Struggling surviving generalists –
And all of their spouses abd wives,
Looking for a substitute for the AMA for their lives.

My Point

My point is: it is hard for the AMA to be everything to everybody,
which may have led to its undoing. The AMA may be too democratic, a formula for paralysis through over-analysis. The AMA has tried to be everything to everybody, and too often it has ended by being nothing to nobody. The AMA can not simultaneously represent the professional and financial interests of academic medicine, specialty doctors, primary care doctors, HMO doctors, government doctors, and left and right wing doctors.

A completely open democracy – with a voice and a veto for everyone – sooner or later disappoints everyone, which may be why the membership of the AMA, and the percentage of actively practicing physicians belonging, has dropped to 15% to 20%. Nobody knows for sure the exact percentage.

In these times of heated debate on how the system ought to be reformed, the low number of doctors belonging to the AMA, and the feeling of a majority of doctors that the AMA does not represent them, poses a political problem.

Who represents medicine at the reform table? The public and other health care stakeholders may think the AMA stands for all doctors, but what if the AMA does not.

Into this leadership vacuum have moved state and local medical societies, which are closer to grassroots doctors and to which perhaps 650.000 of America’s 825,000 doctors belong, and which fall under the umbrella of the Physicians’ Foundation, an organization created in 2003 as the result of a lawsuit against the nation’s major HMOs, and Sermo, a social networking site with 100,000 members, where licensed doctors can exchange unbridled, unfettered, and sometimes divided and uncoherent views of what’s right and wrong with the system. I should also mention Physicians for a National Health Program, an organization of 14,000 physicians, medical students, and health professionals, advocating for a single-payer national health insurance program.

As yet, unfortunately, there is no Pied Piper.